Gestational diabetes

Question 1

risk factors

Answer 1

BMI of > 30 kg/m²

previous macrosomic baby weighing 4.5 kg or above

previous gestational diabetes

first-degree relative with diabetes

family origin with a high prevalence of diabetes (South Asian, black Caribbean and Middle Eastern)

Question 2

screening

Answer 2

OGTT

Question 3

Ddx with OGTT

Answer 3

fasting glucose is >= 5.6 mmol/L
2-hour glucose is >= 7.8 mmol/L

Question 4

Mx of gestational diabetes

Answer 4

seen in a joint diabetes and antenatal clinic within a week

diet

exercise

if the fasting plasma glucose level is < 7 mmol/l a trial of diet and exercise should be offered

if at the time of diagnosis the fasting glucose level is >= 7 mmol/l insulin should be started

if the plasma glucose level is between 6-6.9 mmol/l, and there is evidence of complications such as macrosomia or hydramnios, insulin should be offered

glibenclamide should only be offered for women who cannot tolerate metformin or those who fail to meet the glucose targets with metformin but decline insulin treatment

Question 5

Mx of pre-existing diabetes

Answer 5

weight loss for women with BMI of > 27 kg/m^2

stop oral hypoglycaemic agents, apart from metformin, and commence insulin

folic acid 5 mg/day from pre-conception to 12 weeks gestation

detailed anomaly scan at 20 weeks including four-chamber view of the heart and outflow tracts

tight glycaemic control reduces complication rates

treat retinopathy as can worsen during pregnancy

Question 6

Targets for self monitoring of pregnant women (pre-existing and gestational diabetes)

Answer 6

Fasting 5.3 mmol/l

1 hour after meals 7.8 mmol/l,

2 hour after meals 6.4 mmol/l